Provider Demographics
NPI:1154503753
Name:SIMON, PETER ANTHONY (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:ANTHONY
Last Name:SIMON
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 N PROCTOR ST STE 214
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5338
Mailing Address - Country:US
Mailing Address - Phone:253-232-8722
Mailing Address - Fax:253-548-3040
Practice Address - Street 1:20 N TACOMA AVE STE B
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3133
Practice Address - Country:US
Practice Address - Phone:253-232-8722
Practice Address - Fax:253-627-1753
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60215533101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health